Female Reproductive System

Front 1

• Describe the location of the ovary, its relationships and neurovascular supply
• Describe the uterine tube and the significance of the opening in its lateral end
• Name the parts of the uterus and describe its location, relationships and neurovascular supply
• Describe the structures of the vagina, its location, orientation and relationships
• Describe the relationship of peritoneum to the internal female genitalia including the peritoneal pouches
• Identify and describe the external genitalia
• Describe the innervation of the female genital tract and relate this to the pain of childbirth
• Compare and contrast the development of male and female genitalia

Back 1

Learning Outcomes

Front 2

Uterine adnexa

Back 2

(structures associated with uterus) – ovaries, uterine tubes

Front 3

Vulva /pudendum

Back 3

female external genitalia

Front 4

Introitus

Back 4

external vaginal opening

Front 5

Birth canal

Back 5

cervix, vagina, vestibule of vagina

Front 6

Female Reproductive Tract

Back 6

Front 7

Descent of ovaries

Back 7

Front 8

Female Development

Back 8

Front 9

Mullerian vs Wolffian Duct

Back 9

Mullerian duct:
- Degenerates in males
- In females, it forms the fallopian tubes,
uterus, cervix and upper two thirds of
the vagina
Wolffian duct:
- In the absence of testosterone, it will
degenerate in females
- In males, it forms the epididymis, the
vas deferens and the seminal vesicle

Front 10

Developmental Anomalies

Back 10

Front 11

Ovaries Staging

Back 11

- At sexual maturity, primary oocytes
complete fist meiotic division to become
secondary oocytes (mediated by FSH)
- Secondary follicles look similar to
primary follicles, except they are larger
& have more follicular cells
- Corona radiata is the innermost layer of
the ovum and supplies its nutrients. Zona
pellucida is a protective layer
- Corpus luteum maintains endometrium
of the uterus by secreting progesterone

Front 12

Ovarian Cycles

Back 12

Front 13

Ovarian Attachments

Back 13

- to back of broad ligament by the mesovarium
- to uterus by ligament of the ovary
- to uterine tube by one or more fimbriae

Front 14

Suspensory Ligaments

Back 14

• The suspensory ligament contains the ovarian vessels and attaches the ovaries to the pelvic wall

Front 15

Uterus

Back 15

Uterus (womb)
- Pear-shaped, thick-walled, hollow muscular organ which is the normal site of implantation
- Two parts are the body & cervix
- Cervix has a vaginal and supravaginal part
- Endocervix is mucous membrane lining cervical canal
- Ectocervix is portion of cervix related to vagina (lined by stratified squamous epithelium)
- Layers of the uterus: endometrium (cyclical changes); myometrium (smooth muscle); and perimetrium (serosal covering of peritoneum)

Front 16

Uterine tube

Back 16

Uterine tube (Fallopian tube)
- Transports oocytes from ovary to uterus
- Infundibular end opens into peritoneal
- About 10cm long
- Ampulla is longest part, has widest lumen and is
normal location of fertilisation.

Front 17

Appearance of external os

Back 17

Front 18

Uterus and Uterine Tubes

Back 18

Front 19

Uterosalpingogram

Back 19

Uterosalpingogram (hysterosalpingogram)
- Radiopaque material is injected into uterus through the external os.
- Contrast medium fills triangular-shaped cavity of the body, the lumen of uterine tube, and if the uterine tubes are patent it spills into the
peritoneal cavity on each side
- Purpose: to check for tubal obstruction as a cause of infertility, to check uterus for fibroids, polyps or developmental abnormalities

Front 20

Uterus Relationships

Back 20

Peritoneal relationships: peritoneum reflects from rectum to posterior fornix and uterus
creating the rectouterine pouch; and reflects from uterus to bladder creating the
uterovesical pouch
Superior relationships: intestines. Posterior relationships: rectouterine pouch (with
loops of intestine) and rectum. Anterior relationships: base of bladder

Front 21

Angles of the uterus

Back 21

Front 22

Broad Ligament

Back 22

Broad ligament is a double layer of peritoneum lateral to uterus. Extends to pelvic wall, pelvic floor and uterine tube
Parts: mesosalpinx, mesovarium, mesometrium and suspensory ligament
Between layers of the broad ligament on each side are the ligament of the ovary & round ligament of uterus

Front 23

Round and Ovarian Ligaments

Back 23

Round ligament & ovarian ligament are the remains of the gubernaculum in the female
They attach to the uterus below the uterine tube.
Round ligament passes through inguinal canal to labium majus and steches causing pain during pregancy

Front 24

Support of the Uterus

Back 24

Passive support of the uterus via pubocervical ligament (attaches cervix to pubis), uterosacral ligament (attaches
posterior cervix to sacrum), and transverse cervical ligament (attaches cervix to lateral pelvic wall and sacrum)

Active support of the uterus via the pelvic diaphragm in particular levator ani

Weaker muscles with age and reduced oestrogen lead to more reliance on these ligaments which stretch over time leading to prolapse of uterus

Front 25

Failure of support leads to prolapse

Back 25

Weak muscles or problems with integrity of perineal body result in the ligaments taking more tension

Kegel exercises to strengthen pelvic floor in females may help prevent prolapse

Front 26

Prolapse

Back 26

Front 27

Blood Supply

Back 27

• The uterine and vaginal arteries are branches of the internal iliac artery. The ovarian arteries originate
from the abdominal aorta, inferior to the renal arteries

Front 28

Veins

Back 28

Follows arteries (except erectile tissue, which drains by dorsal vein of clitoris into vesical venous plexus in pelvis)
Right ovarian vein drains to IVC
Left ovarian vein drains to left renal vein

Front 29

Uterus Relationships - Pregnancy

Back 29

Front 30

Physiology of Pregnancy

Back 30

Front 31

Hysterectomy

Back 31

Front 32

Surgical Approaches to hysterectomy

Back 32

Front 33

Ampulla

Back 33

• The ampulla is the longest and widest part of the uterine tubes and is the normal location of fertilisation

Front 34

Anterversion and Anteflexion

Back 34

• Anteversion refers to the 90 degree angle between the cervix and the vagina, while anteflexion refers to
the 170 degree angle between the cervix and body of the uterus

Front 35

Vagina

Back 35

- Fibromuscular structure, 8 cm long x 4 cm wide. Passes forward and down
- Pierced by the cervix à fornices (anterior, lateral, posterior)
- Posterior fornix is deeper and is related to rectouterine pouch (of Douglas).
- Relationships: anterior = bladder; posterior = rectum and perineal body;
lateral = ureter (lateral fornix), levator ani and bulb of vestibule
- Fistulas may develop between vagina & bladder, urethra or rectum

Front 36

Shape of the Vagina

Back 36

Front 37

Fornices

Back 37

Front 38

External Genitala

Back 38

Front 39

Lower Vagina

Back 39

Front 40

Hymen

Back 40

its at the boundary between the embryological outer third of vagina coming from perineium and the inner 2/3

Front 41

Innervation in Female

Back 41

Front 42

Greater and lesser Vestibular Glands

Back 42

The greater vestibular (Bartholin's) glands open at the introitus, while the lesser vestibular (Skene's)
glands open near the urethral orifice

Front 43

Ant. Post. Commissure

Back 43

• The anterior commissure is formed by the union of labia major anteriorly
• The posterior commissure is formed by the union of labia major posteriorly and marks the position of the
perineal body on the skin (surface anatomy)

Front 44

Pelvic Pain line and Female Genitalia

Back 44

• The body of the uterus is above the pelvic pain line, while the cervix is below the pelvic pain line

Front 45

Examination of the cervix

Back 45

Front 46

Bimanual Palpation

Back 46